Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study

Background: The discharging ear presents the otologist with the dilemma of operating on it or not. This study is being undertaken to study and compare the results of type I tympanoplasty in dry ear (no ear discharge at the time of surgery) and wet ear (culture negative consistent ear discharge at the time of surgery).Methods: 50 patients of either sex aged between 18 to 50 years undergoing type-I tympanoplasty were included in the study on the basis of pre-determined clinical criteria. Type I tympanoplasty was performed using temporalis fascia graft by underlay technique. Post-operative data regarding graft uptake and hearing improvement was recorded in the follow up period of three months. Results: The complete graft uptake was there in 88% of the patients in group 1 and 84% patients in group 2. The difference in the two groups was statistically insignificant (p>0.05). The mean pre-operative pure tone average in group 1 was 30.57±7.80 dB while post-operative pure tone average was 20.68±8.22 dB with a mean hearing gain of 9.89 dB. The mean pre-operative pure tone average in group 2 was 35.21±5.98 dB while the post-operative pure tone average was 27.07±9.25 dB with a mean hearing gain of 8.12 dB. There was marked hearing improvement in both the groups post operatively (p<0.001 i.e., highly significant). When hearing improvement was compared between two groups there was no significant statistical difference (p>0.05).Conclusions: The outcome is equally good for type 1 tympanoplasty in dry and wet ear in safe (mucosal) type of chronic suppurative otitis media with respect to graft uptake and hearing improvement.

Section: Discussionmentioning

confidence: 95%

Graft uptake and post-operative hearing outcome with type-I tympanoplasty in dry versus wet ear: a comparative study

Sandhu

Kaur

Singh

et al. 2019

“…7,8 Histopathology of excised remnant TM in wet ears showed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ears which is similar to other studies who have postulated that vascularity and inflammation in cases of active COM has influence on graft uptake. 5,9 In this study the overall success rate in graft uptake following myringoplasty was 88.3%, with 86.7% in wet ears and 90% in dry ears. It was observed that there was no statistical significance (p value of 0.688>0.05) between the 2 groups in relation to graft uptake.…”

Section: Discussionmentioning

confidence: 51%

“…Other studies comparable to this study have shown that presence of ear discharge at the time of surgery has no significant bearing on the results of myringoplasty. 7,[9][10][11][12] A comparison of graft uptake of this study with other studies is given in Table 2. Mean hearing gain observed in wet and dry ears were 3.43 dB and 3.85 dB respectively.…”

Section: Discussionmentioning

confidence: 95%

Comparison of efficacy of myringoplasty in dry and wet ears in chronic otitis media of tubotympanic type

Chandrashekar

2017

Background: The objective of the study was to compare the outcome of myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.Methods: This is a prospective study done in department of ENT Bangalore Medical College and Research Institute during the study period of November 2014 to May 2016, wherein a total of 60 patients of tubotympanic type COM with 30 cases each of dry and wet ears, aged 15-60 years were included. The hearing impairment was assessed and recorded by pure tone audiometry (PTA). After obtaining informed written consent the patients underwent myringoplasty (temporalis fascia graft, underlay technique). Microbiological examination of discharge in wet ears was done and histopathology of the excised remnant TM analyzed in both groups. Both groups of patients were followed up for 3 months and assessed for graft uptake and hearing improvement. PTA was repeated at 3 months postoperatively. Results: Our study included 60 patients of tubotympanic type of COM with 30 cases each with dry and wet ears who underwent myringoplasty. Majority of our patients were in second decade in both the groups. There was slight female preponderance in our study with male to female ratio of 0.93:1. Discharge from ears in wet ears was mucoid in consistency and were culture negative. Histopathology of excised remnant TM in wet ears revealed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ear cases. The overall successful graft uptake following myringoplasty was 88.3% with 86.7% for wet ears and 90% for dry ears with no statistical significance (p value of 0.688>0.05) between the two groups. With respect to hearing improvement post-operatively there was significant hearing improvement in both the groups when compared to preoperative hearing with a mean hearing gain (dB) of 3.43±2.81 in wet ear cases to 3.85±3.05 in dry ear cases, but when compared between the two groups, there was no significant statistical difference (p value of 0.582>0.05).Conclusions: The outcome is equally good for myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media with respect to graft uptake and hearing improvement.

“…Many studies prove that wet or dry ears do not affect the success rate, but it should be mucoid and scanty. 10,11 Rashmi in his study on role of cortical mastoidectomy in type 1 tympanoplasty in 80 patients concluded that cortical mastoidectomy is not routinely necessary in all cases of CSOM but it is of definite help in sclerosed contracted mastoid with edematous polypoidal middle ear mucosa to remove aditus block, as performing mastoidectomy adds time, cost, and increased risk of postoperative complications. 12 In the present study we found out that the success rate in terms of graft uptake is 100% in cases where cortical mastoidectomy is done along with type 1 tympanoplasty, while it is 83.33% when tympanoplasty alone is done.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on type 1 tympanoplasty: anatomical and functional outcomes

Kusumanjali¹,

Chaitanya²

2019

Background: Tympanoplasty is operation to eradicate disease in middle ear and to reconstruct the hearing mechanism. Present study aims at assessment of success rate and hearing improvement following type I tympanoplasty.Methods: 50 patients with chronic suppurative otitis media, tubotympanic type attending department of ENT are taken up for study screened with clinical history and examination. Type I tympanoplasty performed in all patients. Simple mastoidectomy with type I tympanoplasty performed in 8 patients. Patients are followed after surgery on 7th, 14th days and end of 3 months. Anatomical outcome is assessed in terms of graft uptake. Pure tone audiometry was performed at 3 months and air bone gap is considered to assess outcome. Results: Out of 50 cases, 43 cases (86%) showed good success rate by means of graft uptake. Remaining 5 cases showed residual perforation and 3 cases medialization of graft. In 42 patients type1 tympanoplasty is performed, success rate was 80.95% and in cases with where type1 tympanoplasty with cortical Mastoidectomy was done and the success rate was 100%. In the present study mean pre op AB gap was 27.65 dB and mean post op AB gap was 19.07 dB. The difference between the two, i.e., AB gap closure was 8.52 dB which is statistically significant.Conclusions: Type-1 tympanoplasty using temporalis fascia with underlay technique have good surgical success rate with excellent improvement of hearing. Cortical mastoidectomy can be planned depending on the status of the middle ear mucosa.